用"破窗理论"带教临床见习护生

1969年美国斯坦福大学心理家菲利普、津巴多进行一项实验，他用两辆一模一样汽车，其中一辆停在加州帕洛尔拖的中产阶级社区，放1w也无人理睬；另一辆停在相对杂乱的纽约布朗克斯区，这辆车的车牌被摘掉，把顶窗打开，结果当天就被偷走了。后来，津巴用锤子把停在加州帕洛尔拖的中产阶级社区那辆车玻璃敲了个大洞。接果，仅仅过了几个小时，那辆车就不见了。基于这项实验，政治学家威尔逊和犯罪学家凯琳提出了"破窗效应"理论，他们认为院如果有人打坏了一幢建筑物的窗户玻璃，而这扇窗户没有及时得到维修，别人就可能受到某些示范的纵容去打烂更多窗户[1]。临床见习是将理论课与临床实践相结合的关键环节，也是职业生涯的第一步，此阶段的见习生可塑性强，为了让见习生很快适应并融入临床工作中，减少或避免护理中存在缺陷，为此，将"破窗理论"应用在带教管理中，起到防微杜渐的作用。     

破窗理论与护花原理

心理学家凯琳曾注意到一个问题:在她上班的路旁,有一座非常漂亮的大楼,有一天,她注意到楼上有一窗子的玻璃被打破了,那扇破窗与整座大楼的整洁美丽极不调谐,显得格外刺眼。又过了一段时间,她惊奇地发现:不但那扇破窗没得到及时的维修,反而又增加了几个带烂玻璃的窗子……     

护士长怎样调动护士的积极性

世界卫生组织提出："护理管理是为了提高健康水平,系统地运用护士的潜在能力和有关其他人员的设备、环境及社会活动的过程。"为了实现这管理目标、护理的模式也应转向以调动人的积极因素为中心,实行主动地参与管理。要调动护士的积极性,单靠行政命令是难于奏效的,必须以合理的需要为基础,通过激励使护士不是因为外部压力而是因为内部动力去努力工作。护士长是一样护理管理系统中最基层,最具体的领导者和指挥者,是护理队伍的带头人,其本身素质的高低与医院的护理质量有着密切的联系,因此,护士长要加强自身建设,在管理中要充分应用需要理论和激励理论。下面是本人在护士长岗位上的一些体会。     

“护理管理信息系统”应用管理体会

“护理管理信息系统”是我院开发的现代护理管理软件，它与国家“金卫工程”中的“军字1号”医院信息管理系统实现了无缝挂接。其设计思想主要依据现代护理管理特点，引用现代人力资源管理及信息学方法，充分利用网络资源共事优势，对护理办公、护理人力资源、护理质量、护理成本进行实时有效管理，使之达到科学化、标准化、网络化的目的。现已在许多医院推广应用。在应用中我们认为应做好的四个方面的工作：系统字典库的维护；管理制度的建立；相关人员约系统培训；实时动态管理与监测。从而建立一个有序、规范的网上信息运作环境，确保在护理管理工作中产生的各类数据的准确、及时、完整、客观，为科学管理、科学计划、科学决策提供可靠依据。     

实施柔性管理，提高传染科护理管理品质

目的：采取柔性管理的"柔"原则与"软"控制的非强制方式，坚持"以人为本"，进一步提高护理管理水平。方法传染科护理管理需要学习和引进柔性管理理论，管理者的个人素质要提高，要对护士予以肯定，激励鼓舞护士，加强沟通，采取工作丰富化轮换岗位的制度，实行"以人为本"的管理方法。结果现行的护理管理模式在引入并应用了柔性管理理论后，得到了完善和改进，调动了护士工作的创造性和主动性，使患者得到了更好的服务。结论柔性管理促进了传染科护理队伍建设的稳定和发展，提供了良好的工作氛围，患者对护理的满意度很大的提高，保障优质护理的持续开展。     

暗示性的测量及其对学习成绩的影响

参照心理学原理，采用自行设计的工具，对１０９名中学生的暗示性作了测量，并与其学习成绩对比分析。结果：１．女性的暗示性高于男性；２．同性别内，暗示性高的学习成绩在总体上比暗示性低的好。     

心理暗示——治病与致病的重要因素

在某些文化落后地区,一直流传着一些神秘的甚甚至可称为迷信的巫术,施术者声称能施展某种超自然的“法术”。施术时,焚香请“仙”,口中念念有词,之后则令病人或喝“仙水”、服“仙药”或佩带什么“符咒”。奇怪的是,经过如此一番折腾,有的病人竟好起来,这其实是一种原始的心理暗示治疗。我们知道,人的愿望、观念、情感、态度在一个人的心中是起作用的,这就是暗示。暗示是任性的基本属性之一。人与人的差别在于有的人容易接受暗示以及暗示性的高低不同。暗示性高低与个体的年龄、性别、个性、心理活动过程等相关。在相同的环境中,女性往往比男性容易接受暗示,儿童比成人容易接受暗     

临床心理护理理论初探

心理护理是医院临床护理工作中的一个重要方面。在实践中，护理人员对怎样做好心理护理，往往觉得难以把握，这在很大程度上是由于心理护理理论基础的空洞和薄弱造成的。要提高临床心理护理水平，就应加强相关基础理论的建设。1对病入开展心理护理，先对病人心理的性质有理论上的解释在临床实践中，发现一个病人需要心理护理，往往是观察到这个病人有一些反常的心理现象，如焦虑、沮丧、恐惧等。这些现象是表面性的，作为心理护理人员应进一步追究是什么原因导致反常心理的出现？病人反常心理现象必然与患病有关系，患病是因，反常心理现象…     

手术室正性暗示语言及细节护理对患者的影响

目的研究100例手术患者给予细节护理以及术中暗示性语言措施的临床疗效。方法选择100例自20111年5月~2013年6月在我院的腹部手术患者,采用抽签方式随机的分为两组,分别是对比组和研究分析组,各组患者为50例,研究组在常规护理的基础上采用手术室语言和细节护理,对比组的50例患者采取常规护理方法,观察两组手术时间、患者的舒适度和术后对护理人员的满意度。结果两组患者在生理和心理舒适度上,研究组明显优于对比组,研究组患者满意度明显高于对比组,其满意度百分比分别是98%和76%,以<0.05为标准,具有统计学差异,同时研究手术时间也比对比组少组。结论对手术患者实施细节护理和术中暗示性语言可以缓解患者紧张情绪,使患者在手术中更加舒适,值得推广于临床。     

妇产科护理管理研究进展

就管理本身而言它既是一门科学，也是一门艺术，就当前的形势下，对于医院妇产科而言做好护理管理需要的不单单是经验，更需要的是现代管理理论以及行之有效的管理技巧。在妇产科中高质量的护理管理可以很好的促进护理质量的提高，使医院妇产科护理更为规范化和科学化。在这样的背景下研究妇产科的护理管理是具有积极意义的，通过对妇产科护理管理的研究能够为妇产科管理的有效实施提供一定的指导并在最终促进产科护理质量全面的、可持续性的提升。因此在本文中作者就在相关研究的基础上，对目前妇产科护理管理的研究进展情况进行了阐释，以此为妇产科护理管理的有效开展与实施给予一定的参照。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.